Provider Demographics
NPI:1790661528
Name:MALCOMSON, NIHA ABHYANKAR
Entity type:Individual
Prefix:
First Name:NIHA
Middle Name:ABHYANKAR
Last Name:MALCOMSON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21976 75TH AVE # 1F
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3044
Mailing Address - Country:US
Mailing Address - Phone:718-772-2848
Mailing Address - Fax:
Practice Address - Street 1:21976 75TH AVE # 1F
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3044
Practice Address - Country:US
Practice Address - Phone:718-772-2848
Practice Address - Fax:718-772-2848
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach